Low-dose, short-acting, angiotensin-converting enzyme inhibitors as rescuetherapy in pregnancy

Objective: To assess the risks and potential benefits of low-dose angiotens in-converting enzyme (ACE) inhibitor treatment in pregnancies complicated b y severe hypertension. Methods: A retrospective review of pregnant women treated with ACE inhibito rs was conducted. Hemodynamics before and after treatment were assessed by using Doppler technique to measure cardiac output. Data were analyzed by us ing the Wilcoxon signed-rank test. Maternal and neonatal outcomes were asse ssed by chart review and phone interview. Results: Ten pregnancies were identified in which ACE inhibitor therapy was initiated in pregnancy for severe, unresponsive vasoconstricted hypertensi on; three were complicated by severe chronic hypertension, 4 by renal insuf ficiency, and 3 by severe preeclampsia. Treatment was limited to a low-dose , short-acting ACE inhibitor (captopril, 12.5 to 25 mg/day). Treatment was associated with an increase in cardiac output from 5.7 +/- 1.5 L/minute to 7.4 +/- 1.4 L/minute (P<.01) and a reduction in total peripheral resistance from 1770 +/- 670 to 1222 +/- 271 dyne . sec . cm(-5) (P =.005). No fetal or neonatal complications were observed. The probability of observing one o r more adverse neonatal outcome in this sample, based on an assumed true ri sk of 5% and 10%, was calculated to be 12% and 50%, respectively. Conclusion: Low-dose captopril therapy was associated with improvement in m aternal hemodynamics and, in cases complicated by severe hypertension and r enal insufficiency, successful continuation of pregnancy. Fetal and neonata l complications were not experienced, but complication rates of 5-10% could have been missed because of the small number of exposed pregnancies. (Obst et Gynecol 2000;96: 956-61. (C) 2000 by The American College of Obstetricia ns and Gynecologists.).